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Nadia Ilse, a bullied 14-year-old from the US, made the news recently when she was granted $US40,000 in plastic surgery by the Little Baby Face Foundation, a non-profit that assists children with facial deformities.

Nadia's "deformity" was that her ears protruded, resulting in relentless "Dumbo" jibes at school.

She'd been begging her mother for otoplasty, or ear-pinning, since she was ten. It's unclear how much her ears bothered her on a personal level - or if you can even separate the personal from the external in this case - but when it came to verbal torture from her peers, the mental anguish isn't hard to imagine. (Just cast your mind back to the wobbly roller-coaster ride of hell that was adolescence, and envisage bonus crippling taunts about your body.)

In an interview with CNN (below), Nadia says the bullying "hurt so much", morphing her naturally talkative self into an antisocial and withdrawn version. Observing the results of her surgery - which also included rhinoplasty (a 'nose job') and mentoplasty (a 'chin job') - she says, "I look beautiful, this is exactly what I wanted, I love it."

Naturally, the Nadia story has prompted an outcry. You escape bullying from working on your self-esteem, not by going under the knife, says everybody. How will girls ever learn their self-worth if surgery is presented as an answer to their insecurities?

Except, I don't think it's that simple. I think that's an obvious, knee-jerk reaction which fails to address the reality of the situation: that self-esteem for adolescent girls is near impossible. Especially in the face of appearance-related bullying, which has the biggest backer of all - society and culture. You can chant all the self-love mantras you like, but you may as well try to smash a brick wall with play-doh. It just won't make a dent.

The thing is, young girls already know the measure of their worth: it stares back at them every day from magazines, advertisements, television, and other inescapable gloss dispensers. The message is loud and clear.

On top of which, where is the line in the sand between something that's obviously debilitating (like a cleft palate), and something that could be passed off as adolescent angst? And what's ultimately more damaging to the psyche - surgery, and the metaphorical white flag that represents, or bullying, with its proven psychological aftershocks?

Clearly, surgery isn't necessarily the answer - or in any way an ideal one. But the choice between two evils is never black and white. The parents of 13-year-old Nicolette Taylor, who had nose surgery last year to overcome bullying, know it. So do the parents of seven-year-old Samantha Shaw, who also had otoplasty to quell harassment. (Although Samantha had never actually been bullied, casting even more murk over the issue.)

The truth is that the ethics of self-modification is one huge grey area, especially where age is concerned. As Nadia herself knows. When asked about those who admonish her choice, she says simply, "They're right."

Follow Rebecca Kamm on Twitter.Is surgery ever the answer for appearance-related bullying? Should plastic surgery be banned for those under 18? Or are the effects of bullying bad enough that it should be considered as a solution?